(602) 604-8941

Scoliosis

Few diagnoses hit parents as hard as Adolescent Scoliosis. Life is good- their child is in the prime of adolescence, competing in soccer and basketball, then suddenly SOMEONE ELSE discovers a curve in their favorite teenager, making them feel inadequate as parents, missing something so crucial and now so obvious.

The fact is, you are good parents. Scoliosis just happens, in most cases, to occur when you are no longer seeing you children run through the house in their underwear, no longer dressing or bathing your children, and losing them to their rooms, cell phones and video games. What your Pediatrician or School Nurse has seen is a rotation of the spine, which actually is often an indicator of a curvature as seen on xray.

Adolescent Scoliosis has Genetic roots, although we don’t have a complete handle on the true inheritance. We know it affects girls 5 to 8 times as often as boys, but it is not a “girl’s disease”. Usually, it is not affecting your child at all when discovered, and our treatment is based on preventing future problems. What we might suggest is dependent on your child’s maturity (not just age), growth remaining, curve magnitude, and other minor factors that suggest how likely the curve is to progress. Again, we want to prevent problems down the road- like impairment of heart and lung function, which may happen when curves are 85 degrees and higher.

What tools do we have? First, we may be able to predict risk based on age and menarchal status coupled with curve size. Second, in some cases, we can test for genetic markers (from saliva), but curves need to be in a specific range, and, since this test was developed in Utah, it is not yet tested for all racial groups. Generally, we want to beat the natural history if the curve is to progress, but we also want to prevent unnecessary treatment as well. If we can predict which curves do not need treatment- even by follow up with xrays- we can lower long term radiation exposure and unnecessary bracing. If patients present too young, an MRI might be indicated to find other causes of the curve.

Some patients are easy. For example, a small curve in a mature 17 year old will not progress. A 60 degree (large) curve in a 14 year old will progress and we probably would suggest surgery. Curves in between, such as a 30 degree curve in a growing 13 year old presents the dilemna- has the child begun her menses? Is there a cap over the pelvis (Risser sign)? Will the child wear a brace if prescribed? What is the role of Physical Therapy or Chiropractic treatment?

We might ask simply for observation with periodic xrays if the curve progression is questionable or if the magnitude is small but the child is young. If the child does need treatment, however, bracewear s our mainstay, and does have good, but not universal, support. It does come with the caveat that a minimum of 12 to 14 hours daily is necessary, and that the goal is to contain, but not permanently correct the curve. The final xray will generally equal the pre-brace curve, so we should probably not brace curves that we are already unhappy with. I usually use a hard brace- as enticing as it may be, there is no evidence that the soft, fabric strap brace is any more effective or better tolerated. Treatment usually continues until your child is mature and finished growing.

What if we suggest surgery? This needs to be seen as a tool used at the appropriate time, and not a last resort. Lung function can be compromised, and we do not get that function back if we wait too long. If we do suggest surgery, you should know that this surgery is relatively common, and our results are generally good. The MAJOR complications that parents worry over are uncommon, and most of us belong to the Scoliosis Research Society and compile our statistics. I talk of death and paralysis out load, and they happen approximately 1 in 3000 times in healthy individuals. We monitor the spinal cord during our cases, and stop if we see problems. In general, curves are markedly reduced and hospitalizations are less than a week, with 3 to 4 weeks of fatigue. I am stingy regarding transfusions, and generally get by without blood products. I pride myself on pain management, and use several methods to achieve this. Specifics of this step- surgery- need to be discussed individually.

Hopefully, this has been helpful- Please also visit the website of the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America (both of which I am a member) as well for different perspectives.